Provider Demographics
NPI:1821167750
Name:KOVACS, STACY JOHN (ATC)
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:JOHN
Last Name:KOVACS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2892 ROCKFORD FALLS DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4878
Mailing Address - Country:US
Mailing Address - Phone:904-382-1386
Mailing Address - Fax:904-264-8350
Practice Address - Street 1:2892 ROCKFORD FALLS DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-4878
Practice Address - Country:US
Practice Address - Phone:904-382-1386
Practice Address - Fax:904-264-8350
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL14782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer